Block 3 Final: GU

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important? 1. Strain all urine 2. Limit fluid intake 3. Enforce strict bed rest 4. Encourage a high calcium diet

Strain all urine; Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation.

Which patient is at greatest risk for developing a urinary tract infection (UTI)? 1. A 35 y.o. woman with a fractured wrist 2. A 20 y.o. woman with asthma 3. A 50 y.o. postmenopausal woman 4. A 28 y.o. with angina

A 50 y.o. postmenopausal woman; Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Angina, asthma and fractures don't increase the risk of UTI.

A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: 1. Hematuria 2. Weight loss 3. Increased urine output 4. Increased blood pressure

Weight loss; Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client's uremia. Which finding signals a significant problem during this procedure? 1. Potassium level of 3.5 mEq/L 2. Hematocrit (HCT) of 35% 3. Blood glucose level of 200 mg/dl 4. White blood cell (WBC) count of 20,000/mm3

White blood cell (WBC) count of 20,000/mm3; An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client.

A female client with a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The most appropriate nursing diagnosis for this patient is: 1. Anxiety related to the presence of urinary diversion. 2. Deficient Knowledge about how to care for the urinary diversion. 3. Low Self-Esteem related to feelings of worthlessness 4. Disturbed Body Image related to creation of a urinary diversion.

Disturbed Body Image related to creation of a urinary diversion; It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner.

Which of the following clients is at greatest risk for developing acute renal failure? 1. A dialysis client who gets influenza 2. A teenager who has an appendectomy 3. A pregnant woman who has a fractured femur 4. A client with diabetes who has a heart catheterization

A client with diabetes who has a heart catheterization; Clients with diabetes are prone to renal insufficiency and renal failure. The contrast used for heart catherization must be eliminated by the kidneys, which further stresses them and may produce acute renal failure.

Steroids, if used following kidney transplantation would cause which of the following side effects? 1. Alopecia 2. Increase Cholesterol Level 3. Orthostatic Hypotension 4. Increase Blood Glucose Level

Increase Blood Glucose Level

A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: 1. Is relatively low in cost 2. Allows the client to be more independent 3. Is faster and more efficient than standard peritoneal dialysis 4. Has fewer potential complications than standard peritoneal dialysis

Allows the client to be more independent; The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, home health care personnel, and machines for life-sustaining treatment. The independence is a valuable outcome for some people. CAPD is costly and must be done daily. Side effects and complications are similar to those of standard peritoneal dialysis.

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected? 1. Hypotension 2. Normal body temp 3. Decreased WBC count 4. Elevated BUN and creatinine levels

Elevated BUN and creatinine levels; In a client with acute renal graft rejection, evidence of deteriorating renal function is expected.

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

Headache, deteriorating level of consciousness, and twitching; Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms.

The nurse helps the client with chronic renal failure develop a home diet plan with the goal of helping the client maintain adequate nutritional intake. Which of the following diets would be most appropriate for a client with chronic renal failure? 1. High carbohydrate, high protein 2. High calcium, high potassium, high protein 3. Low protein, low sodium, low potassium 4. Low protein, high potassium

Low protein, low sodium, low potassium; Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high carbohydrate diet along with appropriate vitamin and mineral supplements.

The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action? 1. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration 2. Encourage increased vegetables in the diet 3. Place the client on a cardiac monitor 4. Check the sodium level

Place the client on a cardiac monitor; The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this the client should be placed on a cardiac monitor.

The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis? 1. Myoglobinuria 2. Ketonuria 3. Pyuria 4. Low WBC count

Pyuria; Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low, as indicated in option D. Ketonuria indicates a diabetic state.

The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones? 1. Calcium oxalate 2. Uric acid 3. Struvite 4. Cystine

Struvite; Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.

A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Miley detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: 1. generalized edema, especially of the face and periorbital area. 2. green-tinged urine. 3. moderate to severe hypotension. 4. polyuria.

generalized edema, especially of the face and periorbital area; Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria? 1. Encourage fluid intake 2. Administration of diuretics 3. Irrigation of foley catheter 4. Restricting fluids

Administration of diuretics; To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in alleviating this oliguria.

Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)? 1. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg 2. Limiting fluid intake to 1 L/day 3. Encouraging the client to use a feminine deodorant after bathing 4. Encouraging the client to douche once a day after removal of the indwelling urinary catheter

Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg; Maintaining a closed indwelling urinary catheter system helps prevent introduction of bacteria; securing the catheter to the client's leg also decreases the risk of infection by helping to prevent urethral trauma. To flush bacteria from the urinary tract, the nurse should encourage the client to drink at least 10 glasses of fluid daily, if possible. Douching and feminine deodorants may irritate the urinary tract and should be discouraged.

A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client's plan of care? 1. Keep the AV fistula site dry 2. Keep the AV fistula wrapped in gauze 3. Take the blood pressure in the left arm 4. Assess the AV fistula for a bruit and thrill

Assess the AV fistula for a bruit and thrill; Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. No blood pressures or venipunctures should be taken in the arm with the AV fistula. When not being dialyzed, the AV fistula site may get wet. Immediately after a dialysis treatment, the access site is covered with adhesive bandages.